Provider Demographics
NPI:1174681233
Name:HOUSTON, CHARLOTTE CLARKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:CLARKE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9663 TIERRA GRANDE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4568
Mailing Address - Country:US
Mailing Address - Phone:858-695-2243
Mailing Address - Fax:619-238-5686
Practice Address - Street 1:9663 TIERRA GRANDE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4568
Practice Address - Country:US
Practice Address - Phone:858-695-2243
Practice Address - Fax:619-238-5686
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist